COMMISSION ON AFFORDABLE HOUSING AND HEALTH FACILITY NEEDS FOR SENIOR CITIZENS IN THE 21ST CENTURY
[Working Draft- November 2000]
Background:
Recognizing the growing numbers of Americans over 65 years of age, and the need to develop comprehensive aging-in-place strategies that link affordable shelter with compassionate services through public-private partnerships, Rep. Rick Lazio (R-NY), Chairman of the House Subcommittee on Housing and Community Opportunity, established the "Commission on Affordable Housing and Health Facility Needs for Seniors Citizens in the 21st Century."
Needs of America's Seniors in the Next Century:
 America's elderly population is growing exponentially. Currently, there are more than 33 million Americans age 65 years or older; by the year 2020, this number will grow to almost 53 million, or one in every six citizens.
Accompanying elderly population growth will be increasing concerns with the nation's ability to fund Social Security, Medicaid/Medicare costs and other major federal entitlement programs.
Growth will also be accompanied by other fundamental elderly concerns, including the nation's financial ability to assure the availability of affordable, quality housing and related in-home and institutional healthcare facilities to serve elderly populations ranging from the recently retired, healthy elderly to older, frail elderly and, to otherwise assure quality of life.
While elderly needs will increase, federal resources are likely to be static or shrinking and will focus on funding other elderly-related programs having perceived greater need and urgency.
The private sector is likely to address housing and related healthcare needs of upper income citizens, but without federal support, is unlikely to meet those of less affluent communities, most in need of attention.
Just as important as the overall expansion of the elderly population is the growth of the old-old: The number of person's aged 75 and older will expand from 13 million to 30 million between 1990 and 2030, and those persons aged 85 and older will increase from 3 million to 8 million. (Important to underscore the large growth of persons who are likely to experience problems with activities of living and need supportive housing). These individuals pose the highest risk of needing more costly institutional care, unless they receive comprehensive supportive services, preferably in a congregate setting.
Predictable emphasis on Social Security and Medicaid/Medicare issues is likely to leave housing, quality of life issues and capital availability for elderly facilities in the background. There is a need for a unified approach to assure that these particular concerns are not overlooked in the coming debates and, given limited resources, to define the proper Federal role in the debate.
It is unlikely that any one group can realistically consider the full range of elderly concerns. High profile and reform issues will be the primary focus of debate, leaving a leadership vacuum for other elderly concerns, including capital availability for housing and healthcare facilities.
Although elderly housing and related home-healthcare and institutional needs (including assisted living, intermediate and skilled nursing home care) are independently monitored by several national focus groups, a more coordinated effort may be useful in view of primary focus of elderly debate on entitlement issues. Projected demographics indicate that the time is now for Federal agencies, such as HUD and Health Care Finance Agency (HCFA), to coordinate efforts and financial resources to address the needs of elderly housing with service-rich infrastructure.
In a climate of limited governmental resources, it may also be useful to bring private and governmental sectors together so that elderly capital needs for these purposes may be properly defined and appropriate, workable responses are developed.
It is important to recognize that housing is an integral part of our solution to problems of how to effectively provide long term care in residential settings; in fact, it is the "where" in long term care. Furthermore, integration of supportive services in this setting is the key to prolonged wellness, and, therefore, the ultimate cost-effectiveness of senior housing programs.
Commission Goals:
As detailed in the legislative language, the "Lazio Commission" shall submit to Congress by December 31, 2001, a report that-
- compiles and interprets information regarding the expected increase in the population of persons 62 years of age or older, particularly information regarding distribution of income levels, homeownership and home equity rates, and degree or extent of health and independence of living;
- provides an estimate of the future needs of seniors for affordable housing and assisted living and health care facilities;
- provides a comparison of estimate of such future needs with an estimate of the housing and facilities expected to be provided under existing public programs, and identifies possible actions or initiatives that may assist in providing affordable housing and assisted living and health care facilities to meet such expected needs;
- identifies and analyzes methods of encouraging increased private sector participation, investment, and capital formation in affordable housing and assisted living and health care facilities for seniors through partnerships between public and private entities and other creative strategies;
- analyzes the costs and benefits of comprehensive aging-in-place strategies, taking into consideration physical and mental well-being and the importance of coordination between shelter and supportive services;
- identifies and analyzes methods of promoting a more comprehensive approach to dealing with housing and supportive service issues involved in aging and the multiple governmental agencies involved in such issues, including the Department of Housing and Urban Development and the Department of Health and Human Services; and
- examines how to establish intergenerational learning and care centers and living arrangements, in particular to facilitate appropriate environments for families consisting only of children and a grandparent or grandparents who are the head of the household.
This goal is to be accomplished through "fact finding" to more precisely define issues and focus discussion through testimony and the solicitation of academic papers prepared by experts in the field that might help frame the issues and provide potential solutions.
It is the mission of the Commission to define the Federal Role in the elderly facility debate;
To explore means for Federal, State and Local Governments to "stretch" resources through joint cooperation;
To develop Public-Private Partnerships (with proprietary and non-profit groups) to address capital formation issues for elderly housing with a healthcare infrastructure;
To educate public and private sectors on elderly capital housing and health care needs.
To craft or develop new models of supportive housing that link housing and services (Here the Commission, in an attempt to be forward looking, can draw on innovative approaches from the US and other countries)
To develop strategies to make better use of single family housing as a long term care resource (Most older persons will reside in their own homes; how these homes are built and what features are in them will influence their ability to age in place and affect the costs of care giving); and
To explore how community services and wellness programs can be developed to encourage aging in place in residential settings. (Housing and facilities can be better related to their surrounding Communities that in turn can influence aging in place and the well being of Residents; this would fit with efforts to develop elder-friendly communities).
Process:
The Lazio Commission shall initiate a national debate on affordable housing and healthcare needs and how to address those needs, through a series of Commission hearings across the country led by the co-chairs to explore and define issues of capital formation for the purposes of expanding opportunities for public-private partnerships and to develop strategies for assuring availability of affordable capital to address defined needs.
In preparing and implementing these and other activities, it is anticipated that the Commission will rely upon the expertise of national, state and local organizations and agencies. It is anticipated that the Commission may establish subcommittees and/or advisory committees made up of experts in the field. In addition, the Commission may contract for outside information and data from various groups, organizations, think tanks, and universities.
It is anticipated that the Seniors Commission seeks to achieve its mission, goals and objectives by undertaking the following types of activities:
- Workshops
- Roundtables
- Web Site
- Posted activities, papers, schedules, etc.
- Links to related web sites
- Commissioned papers
- Public Outreach
- Associated events (activities coordinated with pre-arranged conferences, openings or other large-scale events)
- Bibliography
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